Wisdom Tooth Extraction — Procedure Guide, Recovery & Risks | MyMedicPlus

Wisdom tooth (third molar) extraction removes partially or fully impacted lower or upper third molars. Impaction is classified by Winter's angulation (mesioangular, horizontal, distoangular, vertical) and Pell and Gregory depth (A–C), which determines surgical complexity and complication risk.

Indicated for symptomatic impaction causing pericoronitis, adjacent second molar resorption, dentigerous cyst formation, recurrent infection, or pathological fracture risk. Prophylactic removal of asymptomatic third molars remains debated; NICE guidelines recommend against routine prophylactic removal.

Under local anaesthesia (with or without intravenous sedation or general anaesthesia), a mucoperiosteal flap is elevated over the tooth. Bone is removed with a surgical handpiece to expose the crown. The tooth may be sectioned into roots for easier removal. The socket is irrigated and the flap closed with resorbable sutures.

Firm gauze pressure for 20–30 minutes controls immediate bleeding. Ice packs applied externally for 48 hours reduce swelling. Soft diet for 3–7 days; gentle oral hygiene maintained avoiding the socket. Dry socket (alveolar osteitis) occurs in 2–5% of extractions at 3–5 days post-operatively.

Risks include dry socket (2–5%), inferior alveolar nerve injury causing lip and chin numbness (1–5% temporary; less than 1% permanent), lingual nerve injury (less than 1%), infection, haemorrhage, and damage to the adjacent second molar. Risk correlates with impaction depth and angulation.

Extraction success approaches 100% in experienced hands. Soft tissue healing is complete at 3–4 weeks; bony healing at 6–8 weeks. Inferior alveolar nerve injury risk is highest with deep mandibular impactions — CBCT (cone beam CT) is recommended when nerve-root proximity is identified on panoramic radiograph.